Personalisation, Social Prescribing and Communities
At the end of last year I was part of a bid that Locality put together to NHS England who were looking to recruit a pool of voluntary organisations who could act as advisors on a call off basis to inform the work of the integrated personal commissioning pilot sites.
We were surprised to be invited to interview, because our impression was that NHSE were looking for voluntary organisations working with particular ‘client groups’. The majority focus on particular client groups as follows:
We felt that a neighbourhood, community centric model might bring added value to this programme – as opposed to the client/condition specific focus of most of the pilots.
The pilot sites are seeking to create a health and care pathway that has the individual at its heart.
I see the logic to this – we are all individuals with our own aspirations, abilities and needs and our circumstances vary. It is important that services bend to our needs and wishes. However, this approach carries with it the cultural heritage and statutory responsibilities of statutory professional services. So, the language includes terms like ‘assessments’, ‘pathways’, ‘reviews’, ‘care plans’.
This model assumes that the first step to support is determined by engagement with the professionals employed by organisations with statutory responsibilities.
Another pathway approach is social prescribing. Many models assume that someone turns up at a GP (one of the champions for this is Dr Michael Dixon), once there an assessment leads to a referral to a ‘broker’ who connects them with a range of community organisations who help address wider issues (such as indebtedness) or help people strengthen social connectedness and regain confidence through doing an activity they enjoy (eg dancing) or giving something back through volunteering.
The difference with this model is the that its focus is on broadening the traditional health and care offer, recognising the important multi-layered contribution that connection with community can have on wellbeing, social determinants and health.
This is all good stuff – however, both of these models are about changing how professional, statutory services behave.
There is a clear need for this…………..but!
Why do vulnerable individuals have to go to statutory service in order to access community and voluntary services where they live?
There is another way in which the same outcomes are achieved and this does not require the initiative to come from health or care professionals.
Community Anchor organisations are a good example of this – many of them are members of Locality. These are organisations like the eponymous Bromley by Bow but they exist all over the country in Sheffield they include Manor and Castle Development Trust, Darnall Wellbeing, SOAR and ShipShape they have roots in neighbourhoods and take a whole person approach – responding to individuals needs and interests but also providing opportunities to contribute, create and get involved.
The way that community anchor organisations work is based on a different set of assumptions. At their best they work to make places better through building services that are run by community members and that are lightly stitched together – responding to the whole person.
Central to this is a recognition that long term relationships are important – community anchors are not going anywhere – they are part of the neighbourhood.
This assumption about relationships and longevity and the more organic way they work; where entry points are many and various is different to the professional model which has clear points of entry, is constrained with regard to the type of services that can be offered and to whom, and relies on professional review and assessment.
At our interview we were not arguing against the professional care pathway – but were saying that there needs to be a balanced approach which recognises the relationship between the professional care pathway and the fuzzier relationships that exist within communities.
It is very important that statutory organisations such as big NHS providers, Clinical Commissioning Groups and those professionals funded by the state like GPs understand that it is not good enough to just design pathways that reconnect people with communities.
Communities are not just waiting with lots of spare capacity for people to be referred to them. They need investment too – the Rotherham Social Prescribing scheme, one of the biggest in the country invests two thirds of its resources in local community and voluntary organisations.
We should support social prescribing and personalisation pathways but commissioners need to give at least as much weight to investing in grass roots community organisations and building their capacity.
What do you think?